Lower Body EvaluationATC 328

The Foot and Toes

Chapter 4

Foot and Toe Anatomy• 26 bones

– Plus sesamoids

• Rearfoot

• Midfoot

• Forefoot

Rearfoot Anatomy• Calcaneus

– Sustentaculum tali

– Peroneal tubercle

• Talus

Midfoot• Navicular

– Posterior tibialis

• Cuneiforms

• Cuboid

Forefoot Anatomy• 5 metatarsals

– MP or MCP

• 14 phalanges– PIP– DIP– IP

Articulations

Arches• Medial longitudinal arch

• Lateral longitudinal arch– Rarely injured

• Transverse metatarsal arch– 1st and 5th metatarsal weight bearing

Medial Longitudinal Arch

• Calcaneus, talus, navicular, first cuneiform, first metatarsal

• Supporting structures– Plantar fascia– Plantar calcaneonavicular ligament “spring

ligament”– Deltoid ligament– Long plantar ligament

Muscular Anatomy• Intrinsic Muscles

– Extensor digitorum brevis– Who cares!!!

• Extrinsic Muscles– Flexor digitorum longus– Flexor hallucis longus– Gastrocnemius/soleus complex– Peroneals– Plantaris– Tibialis posterior/anterior– Extensor digitorum longus– Extensor hallucis longus

Evaluation• History

– Blah, blah, blah

• Observation– Edema, effusion, deformity, etc

• Palpation

• Special Tests– ROM– MMT– Stability– Etc.

Toe Injuries• MP, DIP, PIP, IP sprains• 1st MP joint sprain (turf toe)

– Hyperextension mechanism– Rule out fx– Valgus, varus, glide testing– Treatment options

Metatarsal Sprains• Intermetatarsal glides

• Tarsometatarsal glides

• Midtarsal glides ???

Pes Planus vs. Pes Cavus• Most often are congenital

abnormalities• Other causes

– Ligaments– Muscles– Accessory navicular– Tarsal coalition– Plantar fascia

• Navicular drop test• Complications associated with

these arch types?

Transverse Metatarsal Arch

• Most common problem is a loss of this arch.

• Consequences of fall TMA

Plantar Fasciitis• Causes

– Acute and chronic

• Signs and symptoms– Pain at medial calcaneal tubercle– AM pain– Decreased ROM/MMT

• Treatment

• Rupture– Acute and steroids

Heel Spurs• Related to Plantar Fasciitis?

• Primary complaint– Pain with heel strike

• Treatment– Similar to plantar fasciitis– Surgery with chronic cases

Tarsal Coalition• Bony, fibrous, or cartilaginous

union of tarsal bones• Most often affects talus,

calcaneus, and/or navicular

• S/S– Rigid flatfoot– Calcaneal valgus– Forefoot abduction– NWB and WB identical

• Treatment

Tarsal Coalition

Tarsal Tunnel Syndrome• Compression of posterior tibial nerve

Tarsal Tunnel Syndrome• Causes

– Acute: inversion or eversion– Chronic: structural and

biomechanical abnormalities

• S/S– Plantar/medial foot pain– Positive Tinel sign

• Treatment

Metatarsal Fractures• Stress fractures

– Morton’s toe

• Acute fractures– Avulsion of base of 5th

– Jones’ fracture

Phalangeal Fracture• S/S

– Pain– Swelling– Positive compression/percussion– Crepitus

• Treatment– Buddy taping– Stiff insert– Relief pad/bar

Intermetatarsal Neuroma• 3 interdigital nerve most common

– Morton’s Neuroma

• Fibrous formation and demyelenization

• Causes– Thickened/shortened transverse

ligament– Fallen transverse arch– Excessive forefoot weight bearing– Excessive pronation– Shoes?

Interdigital Neuroma• S/S

– Pain and paresthesia– Nodule– Pain with compression– Decreased pain barefoot– Pencil eraser “test”

• Treatment